CARC 45: charge exceeds fee schedule or maximum allowable
What claim adjustment reason code 45 means on a remittance, why it is usually expected, and how to use it to check whether the allowed amount matches your contract.
By PayerBeacon. Published . Updated .
What does CARC 45 mean on a remittance?
CARC 45 means the billed charge was higher than the payer's fee schedule, maximum allowable, or contracted rate. It is usually an expected contractual write-off, not proof of underpayment.
It depends. If the payer allowed your contracted rate, CARC 45 is the expected write-off and no recovery is due. If the allowed amount is below your contract, compare the line with the rate and check any other adjustments before treating it as an underpayment.
What CARC 45 means
Claim adjustment reason code 45 reads "charge exceeds fee schedule, maximum allowable, or contracted or legislated fee arrangement." It tells you the amount billed was higher than the amount the payer allows for that service.
It normally appears with the CO (contractual obligation) group code, and the amount beside it is the difference between the billed charge and the allowed amount.
Why it is not an underpayment by itself
For an in-network practice, a CARC 45 adjustment on a paid line is expected, because billed charges are usually higher than contracted rates. The code describes the write-off, not whether the payer paid the right amount.
Whether the payment is correct depends on whether the allowed amount equals the rate your contract sets for that service.
How to check the allowed amount
When CARC 45 is the only contractual adjustment on a line, subtract its amount from the billed charge to get the allowed amount the payer applied.
Compare that figure with the contracted rate for the procedure code, modifier, and date of service. If the payer allowed less than the contract says, the line is worth reviewing. Check any other adjustments on the line first, since they can change the result.